Log in | Register

Cerebral perfusion pressure and cerebral tissue oxygen tension in a patient during cardiopulmonary resuscitation

Roberto Imberti| Guido Bellinzona| Francesca Riccardi| Michele Pagani| Martin Langer
Brief Report
Volume 29, Issue 6 / June , 2003

Pages 1016 - 1019


Objective: To report on the effects of cardiopulmonary resuscitation (CPR) instituted immediately after a cardiac arrest on cerebral perfusion pressure (CPP) and cerebral tissue oxygen tension (PbrO2).

Design: Case report.

Setting: ICU of a university hospital.

Patient: A head-injured 17-year-old man submitted to multimodal neurological monitoring underwent sudden cardiac arrest and successful CPR.

Interventions: External chest compression, 100% oxygen ventilation, volume expansion and standard ACLS protocols.

Measurements and results: Heart rate, ECG, mean arterial blood pressure (MABP), ETCO2,PaO2, intracranial pressure (ICP), CPP and PbrO2 were continuously monitored during CPR and data recorded at 15-s intervals by a dedicated personal computer. At the onset of the cardiac arrest, PbrO2 decreased to zero. The institution of CPR resulted in a progressive increase of MABP, CPP and PbrO2. Assuming, on the basis of previous experimental and clinical reports, 8 mmHg PbrO2 as a possible ischaemic/hypoxic threshold value, during the first 6.5 min of CPR, PbrO2 values were below this threshold (range 0–7 mmHg) and CPP values were <25 mmHg for 81.5% of the time. In the following 5.5 min, more efficient CPR generated CPP values >25 mmHg for 77.3% of the time. These values were associated with a PbrO2 >8 mmHg (range 8–28 mmHg) at all times.

Conclusions: In the clinical setting of a witnessed cardiac arrest, immediate institution of CPR can be effective in generating PbrO2 values above a supposed ischaemic/hypoxic threshold when CPP is >25 mmHg. PbrO2 monitoring by the Licox system is sensitive and reliable, even at low values, and can be suitable for evaluating cerebral oxygenation during experimental CPR.



  1. Safar P (1986) Cerebral resuscitation after cardiac arrest: a review. Circulation 74 (Suppl IV):138–153
  2. International Guidelines 2000 for CPR and ECC (2000) A consensus on science. Resuscitation 46:1–448
    • View reference on publisher's website
    • View reference on PubMed
  3. Nozari A, Rubertsson S, Gedeborg R, Nordgren A, Wiklund L (1999) Maximization of cerebral blood flow during experimental cardiopulmonary resuscitation does not ameliorate post-resuscitation hypoperfusion. Resuscitation 40:27–35
    • View reference on publisher's website
    • View reference on PubMed
  4. Farrar JK (1991) Tissue PO2 threshold of ischemic cell damage following MCA occlusion in cats. J Cereb Blood Flow Metab 11 (Suppl 2):S553
  5. Kariman K, Hempel FG, Jobsis FF (1983) In vivo comparison of cytochrome a/a3 redox state and tissue PO2 in transient anoxia. J Appl Physiol 55:1057–1063
    • View reference on PubMed
  6. Kiening KL, Unterberg AW, Bardt TF, Schneider G-H, Lanksch WR (1996) Monitoring of cerebral oxygenation in patients with severe head injuries: brain tissue PO2 versus jugular vein oxygen saturation. J Neurosurg 85:751–757
    • View reference on PubMed
  7. Dings J, Meixensberger J, Amschler J, Hamelbeck B, Roosen K (1996) Brain tissue PO2 in relation to cerebral perfusion pressure, TCD findings and TCD–CO2 reactivity after severe head injury. Acta Neurochir 138:425–434
  8. Gopinath SP, Valadka AB, Uzura M, Robertson CS (1999) Comparison of jugular venous oxygen saturation and brain tissue PO2 as monitors of cerebral ischemia. Crit Care Med 27:2337–2345
    • View reference on PubMed
  9. Imberti R, Bellinzona G, Langer M (2002) Cerebral tissue PO2 and SjvO2 changes during moderate hyperventilation in patients with severe traumatic brain injury. J Neurosurg 96:97–102
    • View reference on PubMed
  10. Bruzzone P, Dionigi R, Bellinzona G, Imberti R, Stocchetti N (1998) Effects of cerebral perfusion pressure on brain tissue PO2 in patients with severe head injury. Acta Neurochir 71 (Suppl):111–113
  11. Lang EW, Czosnyka M, Mehdorn M (2003) Tissue oxygen reactivity and cerebral autoregulation after severe traumatic brain injury. Crit Care Med 31:267–271
    • View reference on PubMed
  12. Shaffner DH, Eleff SM, Brambrink AM, Sugimoto H, Izuta M, Koehler RC, Traystman J (1999) Effect of arrest time and cerebral perfusion pressure during cardiopulmonary resuscitation on cerebral blood flow, metabolism, adenosine triphosphate recovery, and pH in dogs. Crit Care Med 27:1335–1342
    • View reference on PubMed

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement